Showing papers in "Archivos De Bronconeumologia in 2017"

Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary

Abstract: This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD (GOLD) 2017 Report focuses primarily on the revised and novel parts of the document. The most significant changes include: 1) the assessment of COPD has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; 2) for each of the groups A to D, escalation strategies for pharmacological treatments are proposed; 3) the concept of de-escalation of therapy is introduced in the treatment assessment scheme; 4) nonpharmacologic therapies are comprehensively presented and; 5) the importance of comorbid conditions in managing COPD is reviewed.

Guía española de la enfermedad pulmonar obstructiva crónica (GesEPOC) 2017. Tratamiento farmacológico en fase estable

Abstract: The clinical presentation of chronic obstructive pulmonary disease (COPD) varies widely, so treatment must be tailored according to the level of risk and phenotype. In 2012, the Spanish COPD Guidelines (GesEPOC) first established pharmacological treatment regimens based on clinical phenotypes. These regimens were subsequently adopted by other national guidelines, and since then, have been backed up by new evidence. In this 2017 update, the original severity classification has been replaced by a much simpler risk classification (low or high risk), on the basis of lung function, dyspnea grade, and history of exacerbations, while determination of clinical phenotype is recommended only in high-risk patients. The same clinical phenotypes have been maintained: non-exacerbator, asthma-COPD overlap (ACO), exacerbator with emphysema, and exacerbator with bronchitis. Pharmacological treatment of COPD is based on bronchodilators, the only treatment recommended in low-risk patients. High-risk patients will receive different drugs in addition to bronchodilators, depending on their clinical phenotype. GesEPOC reflects a more individualized approach to COPD treatment, according to patient clinical characteristics and level of risk or complexity.

Informe 2017 de la Iniciativa Global para el Diagnóstico, Tratamiento y Prevención de la Enfermedad Pulmonar Obstructiva Crónica: Resumen Ejecutivo de GOLD

Abstract: Resumen Este resumen ejecutivo del Informe de 2017 de la Global Strategy for the Diagnosis, Management, and Prevention of COPD (GOLD) se basa principalmente en las modificaciones y novedades del documento anterior. Los cambios mas destacados incluyen: a) se ha diferenciado entre la exploracion espirometrica y la de los sintomas para evaluar la enfermedad pulmonar obstructiva cronica (EPOC). En la propuesta actual, los grupos ABCD se refieren exclusivamente a sintomas y antecedentes de exacerbaciones de los pacientes; b) para cada uno de los grupos, se proponen estrategias de intensificacion de los tratamientos farmacologicos; c) se introduce el concepto de reduccion escalonada de la terapia en el esquema de evaluacion del tratamiento; d) se detalla mas extensamente el tratamiento no farmacologico; y, f) se revisa la importancia de las diferentes co-morbilidades en lo que respecta al tratamiento de la EPOC.

Spanish Guidelines on Treatment of Bronchiectasis in Adults.

Abstract: In 2008, the Spanish Society of Pulmonology (SEPAR) published the first guidelines in the world on the diagnosis and treatment of bronchiectasis. Almost 10 years later, considerable scientific advances have been made in both the treatment and the evaluation and diagnosis of this disease, and the original guidelines have been updated to include the latest therapies available for bronchiectasis. These new recommendations have been drafted following a strict methodological process designed to ensure quality of content, and are linked to a large amount of online information that includes a wealth of references. The guidelines are focused on the treatment of bronchiectasis from both a multidisciplinary perspective, including specialty areas and the different healthcare levels involved, and a multidimensional perspective, including a comprehensive overview of the specific aspects of the disease. A series of recommendations have been drawn up, based on an in-depth review of the evidence for treatment of the underlying etiology, the bronchial infection in its different forms of presentation using existing therapies, bronchial inflammation, and airflow obstruction. Nutritional aspects, management of secretions, muscle training, management of complications and comorbidities, infection prophylaxis, patient education, home care, surgery, exacerbations, and patient follow-up are addressed.

Normativa sobre el tratamiento de las bronquiectasias en el adulto

Abstract: Resumen En 2008, la Sociedad Espanola de Neumologia y Cirugia Toracica (SEPAR) publico las primeras normativas del mundo sobre el diagnostico y tratamiento de las bronquiectasias. Tras casi una decada, muchos han sido los avances cientificos en esta enfermedad, tanto en sus aspectos terapeuticos como en su valoracion y diagnostico. Por ello estas nuevas normativas sobre el tratamiento de las bronquiectasias en el adulto tratan de ofrecer al lector una actualizacion del conocimiento cientifico sobre las posibilidades terapeuticas en bronquiectasias, basandose en un estricto procedimiento metodologico que asegura la calidad del contenido de la misma, y en una amplia cantidad de informacion online que incluye abundante bibliografia. En estas normativas se ha enfocado el tratamiento de las bronquiectasias desde un punto de vista tanto multidisciplinar, que implica las especialidades y escalones asistenciales involucrados, como multidimensional que incluye todos y cada uno de los aspectos que definen a la enfermedad. Asi, se establecen recomendaciones basadas en una exhaustiva revision de la evidencia sobre los tratamientos de la etiologia, de la infeccion bronquial en sus diferentes formas de presentacion y con las diferentes terapias existentes, de la inflamacion bronquial y de la obstruccion al flujo aereo. Se revisan los aspectos nutricionales, el manejo de las secreciones, el entrenamiento muscular, el manejo de las complicaciones y comorbilidades, la profilaxis de la infeccion, los aspectos educacionales, el manejo del paciente en el domicilio, el tratamiento quirurgico, las agudizaciones y el seguimiento de los pacientes.

Spanish Guidelines on the Evaluation and Diagnosis of Bronchiectasis in Adults

Abstract: In 2008, the Spanish Society of Pulmonology (SEPAR) published the first guidelines in the world on the diagnosis and treatment of bronchiectasis. Almost 10 years later, considerable scientific advances have been made in both the treatment and the evaluation and diagnosis of this disease, and the original guidelines have been updated to include the latest scientific knowledge on bronchiectasis. These new recommendations have been drafted following a strict methodological process designed to ensure the quality of content, and are linked to a large amount of online information that includes a wealth of references. These guidelines cover aspects ranging from a consensual definition of bronchiectasis to an evaluation of the natural course and prognosis of the disease. The topics of greatest interest and some new areas are addressed, including epidemiology and economic costs of bronchiectasis, pathophysiological aspects, the causes (placing particular emphasis on the relationship with other airway diseases such as chronic obstructive pulmonary disease and asthma), clinical and functional aspects, measurement of quality of life, radiological diagnosis and assessment, diagnostic algorithms, microbiological aspects (including the definition of key concepts, such as bacterial eradication or chronic bronchial infection), and the evaluation of severity and disease prognosis using recently published multidimensional tools.

Spanish COPD Guidelines (GesEPOC) 2017. Pharmacological Treatment of Stable Chronic Obstructive Pulmonary Disease

Abstract: The clinical presentation of chronic obstructive pulmonary disease (COPD) varies widely, so treatment must be tailored according to the level of risk and phenotype In 2012, the Spanish COPD Guidelines (GesEPOC) first established pharmacological treatment regimens based on clinical phenotypes This approach was subsequently adopted by other national guidelines, and since then, have been backed up by new evidence In this 2017 update, the original severity classification has been replaced by a much simpler risk classification (low or high risk), on the basis of lung function, dyspnea grade, and history of exacerbations, while determination of clinical phenotype is recommended only in high-risk patients The same clinical phenotypes have been maintained: non-exacerbator, asthma-COPD overlap (ACO), exacerbator with emphysema, and exacerbator with chronic bronchitis Pharmacological treatment of COPD is based on bronchodilators, the only treatment recommended in low-risk patients High-risk patients will receive different drugs in addition to bronchodilators, depending on their clinical phenotype GesEPOC reflects a more individualized approach to COPD treatment, according to patient clinical characteristics and level of risk or complexity

Consensus on the Asthma-COPD Overlap Syndrome (ACOS) Between the Spanish COPD Guidelines (GesEPOC) and the Spanish Guidelines on the Management of Asthma (GEMA).

Abstract: Following a proposal by the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), sponsor of the Spanish COPD Guidelines (GesEPOC) and the Spanish Guidelines on the Management of Asthma (GEMA), authors of both papers have unified the criteria for the diagnosis of asthma-COPD overlap syndrome (ACOS). This consensus defines ACOS as the presence in a given patient of three elements: significant smoking exposure, chronic airflow limitation and asthma. Diagnosis is confirmed when a patient (35years of age or older), smoker or ex-smoker of more than 10 pack-years, presents airflow limitation (post-bronchodilator FEV1/FVC<0.7) that persists after treatment with bronchodilators and inhaled corticosteroids (even after systemic corticosteroids in selected cases), and an objective current diagnosis of asthma (according to GEMA criteria). In cases in which the diagnosis of asthma cannot be demonstrated, marked positive results on a bronchodilator test (FEV1≥15% and ≥400mL) or elevated blood eosinophil count (≥300eosinophils/μL) will also be diagnostic of ACOS. The opinion of another 33 experts who had not participated in the consensus was sought using a modified Delphi survey. Up to 80% of respondents gave a very positive opinion of the consensus, and declared that it was better than other previous proposals. The GesEPOC-GEMA consensus on ACOS provides a unique perspective of the diagnostic problem, using a simple proposal and a pragmatic diagnostic algorithm that can be applied at any healthcare level.

Consenso sobre el solapamiento de asma y EPOC (ACO) entre la Guía española de la EPOC (GesEPOC) y la Guía Española para el Manejo del Asma (GEMA)

Abstract: Resumen A instancias de la Sociedad Espanola de Neumologia y Cirugia Toracica (SEPAR), promotora de la Guia espanola de la EPOC (GesEPOC) y de la Guia Espanola para el Manejo del Asma (GEMA), autores de ambas guias han unificado criterios diagnosticos del solapamiento asma y EPOC (Asthma-COPD Overlap [ACO]). Este consenso define al ACO como la coexistencia en un mismo paciente de tres elementos: tabaquismo, limitacion cronica al flujo aereo y asma. La confirmacion diagnostica se establece cuando un paciente (≥ 35 anos) fumador o exfumador (≥ 10 paquetes-ano) presenta obstruccion o limitacion cronica al flujo aereo (FEV1/FVC post-broncodilatador Se solicito la opinion (mediante encuesta Delphi modificada) a otros 33 expertos que no habian participado en la elaboracion del consenso. Un 80% de estos lo valoro positivamente, incluso superior a otras propuestas recientes. El consenso GesEPOC-GEMA sobre ACO proporciona una vision unitaria del problema, con una propuesta conceptual sencilla y un algoritmo diagnostico pragmatico, aplicable en cualquier nivel sanitario de nuestro ambito.

Etiología de las bronquiectasias en una cohorte de 2.047 pacientes. Análisis del registro histórico español

Abstract: Resumen Introduccion Las bronquiectasias son la consecuencia final de multiples patologias. Establecer la etiologia tiene implicaciones clinicas y pronosticas. El objetivo fue evaluar la etiologia de las bronquiectasias en una amplia muestra de pacientes, su posible relacion con factores demograficos, clinicos o de gravedad, asi como analizar las diferencias entre las idiopaticas, las postinfecciosas y las debidas a otras causas. Metodos Estudio multicentrico, transversal, del Registro Historico Espanol de la SEPAR (RHEBQ-SEPAR). Se incluyeron prospectivamente pacientes adultos con bronquiectasias seguidos por neumologos. Para el estudio etiologico se siguieron las recomendaciones y pruebas diagnosticas protocolizadas en el registro que posteriormente fueron recogidas en la normativa SEPAR de bronquiectasias. Resultados Se analizaron 2.047 pacientes de 36 centros espanoles. La edad media fue de 64,9 anos y el 54,9% fueron mujeres. La etiologia se identifico en el 75,8% de los casos (postinfecciosa: 30%; fibrosis quistica: 12,5%; inmunodeficiencias: 9,4%; EPOC: 7,8%; asma: 5,4%; discinesia ciliar: 2,9%, y enfermedades sistemicas: 1,4%). Las distintas etiologias presentaban diferencias demograficas, clinicas y microbiologicas. Las bronquiectasias postinfecciosas y las secundarias a EPOC y asma presentaban mas riesgo de tener peor funcion pulmonar. Los pacientes con bronquiectasias postinfecciosas eran mayores y se diagnosticaban mas tarde. Las bronquiectasias idiopaticas predominaban en mujeres no fumadoras y se asociaban a mejor funcion pulmonar, mayor indice de masa corporal y menor frecuencia de infeccion por Pseudomonas aeruginosa que las de causa conocida. Conclusiones La etiologia de las bronquiectasias se ha identificado en una gran proporcion de los pacientes incluidos en el RHEBQ-SEPAR. Se pueden reconocer diferentes fenotipos relacionados con las distintas causas.

Etiology of Bronchiectasis in a Cohort of 2047 Patients. An Analysis of the Spanish Historical Bronchiectasis Registry.

Abstract: Introduction Bronchiectasis is caused by many diseases. Establishing its etiology is important for clinical and prognostic reasons. The aim of this study was to evaluate the etiology of bronchiectasis in a large patient sample and its possible relationship with demographic, clinical or severity factors, and to analyze differences between idiopathic disease, post-infectious disease, and disease caused by other factors. Methods Multicenter, cross-sectional study of the SEPAR Spanish Historical Registry (RHEBQ-SEPAR). Adult patients with bronchiectasis followed by pulmonologists were included prospectively. Etiological studies were based on guidelines and standardized diagnostic tests included in the register, which were later included in the SEPAR guidelines on bronchiectasis. Results A total of 2047 patients from 36 Spanish hospitals were analyzed. Mean age was 64.9 years and 54.9% were women. Etiology was identified in 75.8% of cases (post-infection: 30%; cystic fibrosis: 12.5%; immunodeficiencies: 9.4%; COPD: 7.8%; asthma: 5.4%; ciliary dyskinesia: 2.9%, and systemic diseases: 1.4%). The different etiologies presented different demographic, clinical, and microbiological factors. Post-infectious bronchiectasis and bronchiectasis caused by COPD and asthma were associated with an increased risk of poorer lung function. Patients with post-infectious bronchiectasis were older and were diagnosed later. Idiopathic bronchiectasis was more common in female non-smokers and was associated with better lung function, a higher body mass index, and a lower rate of Pseudomonas aeruginosa than bronchiectasis of known etiology. Conclusions The etiology of bronchiectasis were identified in a large proportion of patients included in the RHEBQ-SEPAR registry. Different phenotypes associated with different causes could be identified.

Guidelines for the medical treatment of idiopathic pulmonary fibrosis.

Abstract: Idiopathic pulmonary fibrosis is defined as chronic fibrosing interstitial pneumonia limited to the lung, with poor prognosis. The incidence has been rising in recent years probably due to improved diagnostic methods and increased life expectancy. In 2013, the SEPAR guidelines for the diagnosis and treatment for idiopathic pulmonary fibrosis were published. Since then, clinical trials and meta-analyses have shown strong scientific evidence for the use of pirfenidone and nintedanib in the treatment of idiopathic pulmonary fibrosis. In 2015, the international consensus of 2011 was updated and new therapeutic recommendations were established, prompting us to update our recommendation for the medical treatment of idiopathic pulmonary fibrosis accordingly. Diagnostic aspects and non-pharmacological treatment will not be discussed as no relevant developments have emerged since the 2013 guidelines.

Diagnóstico y tratamiento de la tuberculosis con resistencia a fármacos

Abstract: Resumen En las ultimas 2 decadas la tuberculosis con resistencia a farmacos se ha convertido en una amenaza y un reto para la salud publica mundial. El diagnostico y el tratamiento de estas formas de tuberculosis es mucho mas complejo, y el pronostico empeora claramente a medida que se incrementa el patron de las resistencias. Sin embargo, es necesario destacar como con el manejo clinico y programatico adecuado de estos enfermos se puede conseguir la curacion de una mayoria de ellos. En esta normativa se razonan las bases del diagnostico y tratamiento de todos los pacientes afectos de tuberculosis, desde aquellos que tienen formas de la enfermedad con sensibilidad a todos los farmacos hasta aquellos que son portadores de los patrones mas extensos de resistencia. Asimismo, se dan recomendaciones especificas para cada uno de estos supuestos. Tambien se aborda el papel que ya estan teniendo y pueden tener en un futuro inmediato los nuevos metodos moleculares de deteccion de resistencias, los esquemas acortados de tratamiento de la tuberculosis multi-farmacorresistente (TB-MDR) y los nuevos farmacos con actividad frente a Mycobacterium tuberculosis.

Red Blood Cell Distribution Width in Patients With Chronic Obstructive Pulmonary Disease and Healthy Subjects.

Abstract: Background Chronic obstructive pulmonary disease (COPD) increases the risk of cardiovascular disease (CVD). Red blood cell distribution width (RDW) is accepted as a powerful predictor of outcomes in patients with CVD. Aims To study RDW in patients with COPD, and to compare the value of this measurement with clinical, echocardiographic, nutritional and laboratory status. Secondly, we aimed to determine the effect of smoking on RDW values in healthy subjects. Methods One hundred and seventy-five patients with stable COPD and 210 healthy controls were enrolled in the study. Demographic, clinical, nutritional status, echocardiographic, and laboratory characteristics, RDW values were recorded and compared. Results RDW values were higher in the COPD group than in controls (15±2.3% vs 13.8±2.5%, p Conclusion RDW is independently associated with CVD and RVD in patients with COPD. In the healthy population, RDW is also associated with smoking status.

Anti-Influenza Treatment: Drugs Currently Used and Under Development.

Abstract: Influenza is a very common contagious disease that carries significant morbidity and mortality. Treatment with antiviral drugs is available, which if administered early, can reduce the risk of severe complications. However, many virus types develop resistance to those drugs, leading to a notable loss of efficacy. There has been great interest in the development of new drugs to combat this disease. A wide range of drugs has shown anti-influenza activity, but they are not yet available for use in the clinic. Many of these target viral components, which others are aimed at elements in the host cell which participate in the viral cycle. Modulating host components is a strategy which minimizes the development of resistance, since host components are not subject to the genetic variability of the virus. The main disadvantage is the risk of treatment-related side effects. The aim of this review is to describe the main pharmacological agents currently available and new drugs in the pipeline with potential benefit in the treatment of influenza.

Accuracy of a New Algorithm to Identify Asthma–COPD Overlap (ACO) Patients in a Cohort of Patients with Chronic Obstructive Airway Disease

Abstract: Objectives We aimed to characterize the clinical, functional and inflammatory features of patients diagnosed diagnosed with ACO according to a new algorithm and to compare them with those of other chronic obstructive airway disease (COAD) categories (asthma and COPD). Methods ACO was diagnosed in a cohort of COAD patients in those patients with COPD who were either diagnosed with current asthma or showed significant blood eosinophilia (≥300 cells/μl) and/or a very positive bronchodilator response (>400 ml and >15% in FEV1). Results Eighty-seven (29.8%) out of 292 patients fulfilled the ACO diagnostic criteria (12.8% asthmatics who smoked 200 eosinophils/μl in blood and none with non-eosinophilic COPD). ACO, asthma and COPD patients showed no differences in symptoms or exacerbation rate. Mean pre-bronchodilator FEV1 in ACO and asthma were similar (1741 vs 1771 ml), higher than in COPD (1431 ml, p Conclusion This algorithm classifies as ACO all smoking asthmatics with non-fully reversible airway obstruction and a considerable proportion of e-COPD patients, highlighting those who can benefit from inhaled corticosteroids.

Normativa sobre el tratamiento farmacológico de la fibrosis pulmonar idiopática

Abstract: Idiopathic pulmonary fibrosis is defined as chronic fibrosing interstitial pneumonia limited to the lung, with poor prognosis. The incidence has been rising in recent years probably due to improved diagnostic methods and increased life expectancy. In 2013, the SEPAR guidelines for the diagnosis and treatment for idiopathic pulmonary fibrosis were published. Since then, clinical trials and meta-analyses have shown strong scientific evidence for the use of pirfenidone and nintedanib in the treatment of idiopathic pulmonary fibrosis. In 2015, the international consensus of 2011 was updated and new therapeutic recommendations were established, prompting us to update our recommendation for the medical treatment of idiopathic pulmonary fibrosis accordingly. Diagnostic aspects and non-pharmacological treatment will not be discussed as no relevant developments have emerged since the 2013 guidelines.

Disfunción diafragmática: una realidad en el paciente ventilado mecánicamente

Abstract: Muscle involvement is found in most critical patients admitted to the intensive care unit (ICU). Diaphragmatic muscle alteration, initially included in this category, has been differentiated in recent years, and a specific type of muscular dysfunction has been shown to occur in patients undergoing mechanical ventilation. We found this muscle dysfunction to appear in this subgroup of patients shortly after the start of mechanical ventilation, observing it to be mainly associated with certain control modes, and also with sepsis and/or multi-organ failure. Although the specific etiology of process is unknown, the muscle presents oxidative stress and mitochondrial changes. These cause changes in protein turnover, resulting in atrophy and impaired contractility, and leading to impaired functionality. The term ‘ventilator-induced diaphragm dysfunction’ was first coined by Vassilakopoulos et al. in 2004, and this phenomenon, along with injury cause by over-distention of the lung and barotrauma, represents a challenge in the daily life of ventilated patients. Diaphragmatic dysfunction affects prognosis by delaying extubation, prolonging hospital stay, and impairing the quality of life of these patients in the years following hospital discharge. Ultrasound, a non-invasive technique that is readily available in most ICUs, could be used to diagnose this condition promptly, thus preventing delays in starting rehabilitation and positively influencing prognosis in these patients.

Spanish Registry of Patients With Alpha-1 Antitrypsin Deficiency: Database Evaluation and Population Analysis.

Abstract: Introduction and Objective REDAAT, the Spanish Registry of Patients with Alpha-1 Antitrypsin Deficiency, was set up in order to improve knowledge of this disease. This study is an evaluation of the registry and an analysis of its patient population. Methods The registry has a database hosted on the website www.redaat.es . It collects clinical and functional data on patients with PiSZ, ZZ phenotypes and other rare variants. Results Thanks to the collaboration of 124 physicians, the registry currently contains information on 511 individuals from 103 healthcare centers. Of these 511, 348 (74.2%) are Pi*ZZ homozygotes, and 100 (19.5%) are Pi*SZ heterozygotes. More cases are seen in tertiary level hospitals. A total of 81% of the cases have respiratory disease, and a lower proportion of AATD cases were detected by family screening or liver disease. Follow-up data are available for 45% of the cases, and 35% received alpha-1 antitripsin replacement therapy. Conclusions The REDAAT registry is a useful tool for obtaining quality information about this minority disease in routine clinical practice conditions, although it is difficult to obtain follow-up data, and the representativeness of the sample included cannot be determined.

Amplitud de distribución eritrocitaria en pacientes con enfermedad pulmonar obstructiva crónica y en sujetos sanos

Abstract: Resumen Introduccion La enfermedad pulmonar obstructiva cronica (EPOC) incrementa el riesgo de enfermedad cardiovascular (ECV). La amplitud de distribucion eritrocitaria (ADE) se considera un potente factor de prediccion de la evolucion de los pacientes con ECV. Objetivos Analizar los valores de ADE de pacientes con EPOC y compararlos en relacion al estado clinico, ecocardiografico, nutricional y analitico de los pacientes. Por otra parte, nos propusimos analizar el efecto del consumo de tabaco sobre los valores de ADE de sujetos sanos. Metodos En el estudio se incluyeron 175 pacientes con EPOC estabilizados y 210 sujetos sanos. Se registraron y se compararon las caracteristicas demograficas, clinicas, nutricionales, ecocardiograficas y analiticas, y los valores de ADE. Resultados Los valores de ADE fueron mas altos en el grupo de pacientes con EPOC que en el grupo control (15 ± 2,3% vs. 13,8 ± 2,5%, p Conclusion En pacientes con EPOC, la ADE se asocia de manera independiente con la ECV y la DVD. En la poblacion sana, la ADE tambien se asocia con el consumo de tabaco.

Tratamiento antigripal: fármacos actualmente utilizados y nuevos agentes en desarrollo

Abstract: Resumen La gripe es una enfermedad contagiosa altamente prevalente y con significativa morbimortalidad. El tratamiento disponible con farmacos antivirales, de ser administrado de forma precoz, puede reducir el riesgo de complicaciones severas; sin embargo, muchos tipos de virus desarrollan resistencia a estos farmacos, reduciendo notablemente su efectividad. Ha habido un gran interes en el desarrollo de nuevas opciones terapeuticas para combatir la enfermedad. Una gran variedad de farmacos han demostrado tener actividad antiinfluenza, pero aun no estan disponibles para su uso en la clinica. Muchos de ellos tienen como objetivo componentes del virus, mientras que otros son dirigidos a elementos de la celula huesped que participan en el ciclo viral. Modular los componentes del huesped es una estrategia que minimiza el desarrollo de cepas resistentes, dado que estos no estan sujetos a la variabilidad genetica que tiene el virus. Por otro lado, la principal desventaja es que existe un mayor riesgo de efectos secundarios asociados al tratamiento. El objetivo de la presente revision es describir los principales agentes farmacologicos disponibles en la actualidad, asi como los nuevos farmacos en estudio con potencial beneficio en el tratamiento de la gripe.

Diabetes is Associated with Severe Adverse Events in Multidrug-Resistant Tuberculosis.

Abstract: Introduction Diabetes mellitus (DM), a very common disease in Mexico, is a well-known risk factor for tuberculosis (TB). However, it is not known by which extent DM predisposes to adverse events (AE) to anti-TB drugs and/or to worse outcomes in patients with multidrug-resistant (MDR-TB) and extensively drug-resistant TB (XDR-TB). The main objective of this study was to describe the outcomes of TB treatment, the impact of DM and the prevalence of AE in a cohort of patients with MDR-/XDR pulmonary TB treated at the national TB referral centre in Mexico City. Results Ninety patients were enrolled between 2010 and 2015: 73 with MDR-TB (81.1%), 11 with pre-XDR-TB (12.2%) and 6 (6.7%) with XDR-TB, including 49 (54.4%) with DM, and 3 with Human Immunodeficiency Virus (HIV) co-infection (3.3%). In 98% of patients, diagnosis was made by culture and drug susceptibility testing, while in a single case the diagnosis was made by a molecular test. The presence of DM was associated with an increased risk of serious drug-related AEs, such as nephrotoxicity (Odds Ratio [OR]=6.5; 95% Confidence Interval [95% CI]: 1.9–21.8) and hypothyroidism (OR=8.8; 95% CI: 1.8–54.2), but not for a worse outcome. Conclusions Our data suggest that DM does not impact second-line TB treatment outcomes, but patients with DM have a higher risk of developing serious AEs to drug-resistant TB treatment, such as nephrotoxicity and hypothyroidism.

Skeletal Muscle Dysfunction in COPD: Novelties in The Last Decade.

Abstract: CIBERES, FIS 14/00713, SEPAR 2013, SEPAR 2016, FUCAP 2011, FUCAP 2012, FUCAP 2014, FUCAP 2016.

Diaphragm Dysfunction in Mechanically Ventilated Patients

Abstract: Muscle involvement is found in most critical patients admitted to the intensive care unit (ICU). Diaphragmatic muscle alteration, initially included in this category, has been differentiated in recent years, and a specific type of muscular dysfunction has been shown to occur in patients undergoing mechanical ventilation. We found this muscle dysfunction to appear in this subgroup of patients shortly after the start of mechanical ventilation, observing it to be mainly associated with certain control modes, and also with sepsis and/or multi-organ failure. Although the specific etiology of process is unknown, the muscle presents oxidative stress and mitochondrial changes. These cause changes in protein turnover, resulting in atrophy and impaired contractility, and leading to impaired functionality. The term 'ventilator-induced diaphragm dysfunction' was first coined by Vassilakopoulos et al. in 2004, and this phenomenon, along with injury cause by over-distention of the lung and barotrauma, represents a challenge in the daily life of ventilated patients. Diaphragmatic dysfunction affects prognosis by delaying extubation, prolonging hospital stay, and impairing the quality of life of these patients in the years following hospital discharge. Ultrasound, a non-invasive technique that is readily available in most ICUs, could be used to diagnose this condition promptly, thus preventing delays in starting rehabilitation and positively influencing prognosis in these patients.

Registro español de pacientes con déficit de alfa-1 antitripsina: evaluación de la base de datos y análisis de la población incluida

Abstract: Resumen Introduccion y objetivo El Registro espanol de pacientes con deficit de alfa-1 antitripsina (REDAAT) se formo con el objetivo de mejorar el conocimiento sobre del DAAT. En este trabajo se evalua el registro y se analiza la poblacion de pacientes incluida en el. Metodos Dispone de una base de datos alojada en la Web: www.redaat.es . Su base de datos recoge informacion clinica y funcional de individuos portadores de los fenotipos PiSZ, ZZ y variantes raras. Resultados En la actualidad reune informacion sobre 511 individuos procedentes de 103 centros sanitarios, gracias a la colaboracion de 124 medicos. De ellos, 348 (74,2%) son homocigotos Pi*ZZ y 100 (19,5%) heterocigotos Pi*SZ. Existe una mayor concentracion de casos en hospitales universitarios de tercer nivel. El 81% de los casos tiene enfermedad pulmonar y en menor proporcion el DAAT se detecto por cribado familiar o enfermedad hepatica. Se dispone de datos de seguimiento en el 45% de los casos, y un 35% recibieron tratamiento sustitutivo con alfa-1 antitripsina. Conclusiones El REDAAT es una herramienta util para obtener informacion de calidad sobre esta enfermedad minoritaria en condiciones de practica clinica habitual, aunque obtener datos de seguimiento es dificil y no es posible conocer la representatividad de la muestra incluida.

La diabetes se asocia con reacciones adversas graves en la tuberculosis multirresistente

Abstract: Resumen Introduccion La diabetes mellitus (DM), una enfermedad muy frecuente en Mexico, es un factor de riesgo bien conocido para el desarrollo de tuberculosis (TB). Sin embargo, se desconoce en que medida la DM predispone al desarrollo de reacciones adversas (RA) a los farmacos anti-tuberculosis y/o si predispone a un peor resultado en pacientes con pacientes con TB multirresistente (TB-MR) y TB extremadamente resistente (TB-XR). El objetivo principal de este estudio fue describir los resultados del tratamiento anti-tuberculosis, el impacto de la DM y la prevalencia de RA en una cohorte de pacientes con TB pulmonar MR/XR tratados en el centro de referencia nacional para TB, en la Ciudad de Mexico. Resultados Entre 2010 y 2015 se incluyeron 90 pacientes —73 con TB-MR (81,1%), 11 con TB pre-XR (12,2%) y 6 (6,7%) con TB-XR—, 49 (54,4%) de los cuales tenian DM y 3 con co-infeccion por el virus de la inmunodeficiencia humana (VIH) (3,3%). El diagnostico se realizo mediante cultivo y pruebas de farmaco-sensibilidad (PFS) en el 98% de los pacientes y mediante prueba molecular en un caso. La presencia de DM se asocio con un mayor riesgo de RA graves, tales como nefrotoxicidad (odds ratio [OR] = 6,5; intervalo de confianza del 95% [IC 95%]: 1,9-21,8) e hipotiroidismo (OR = 8,8; IC 95%: 1,8-54,2), aunque no con peor resultado del tratamiento. Conclusiones Nuestros datos sugieren que la DM no tiene un impacto sobre los resultados del tratamiento anti-tuberculosis de segunda linea, pero los pacientes con DM tienen mayor riesgo de presentar RA graves secundarias al tratamiento, tales como nefrotoxicidad e hipotiroidismo.

Study of 5 Volatile Organic Compounds in Exhaled Breath in Chronic Obstructive Pulmonary Disease

Abstract: Introduction A major risk factor for chronic obstructive pulmonary disease (COPD) is tobacco smoke, which generates oxidative stress in airways, resulting in the production of volatile organic compounds (VOCs). The purpose of this study was to identify VOCs in exhaled breath and to determine their possible use as disease biomarkers. Method Exhaled breath from 100 healthy volunteers, divided into 3 groups (never smokers, former smokers and active smokers) and exhaled breath from 57 COPD patients were analyzed. Samples were collected using BioVOC ® devices and transferred to universal desorption tubes. Compounds were analyzed by thermal desorption, gas chromatography and mass spectrometry. VOCs analyzed were linear aldehydes and carboxylic acids. Results The COPD group and healthy controls (never smokers and former smokers) showed statistically significant differences in hexanal concentrations, and never smokers and the COPD group showed statistically significant differences in nonanal concentrations. Conclusions Hexanal discriminates between COPD patients and healthy non-smoking controls. Nonanal discriminates between smokers and former smokers (with and without COPD) and never smokers.